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1984, 08-01 Permit App: 00001626 Heat Puimp
* H z w 2 0 5 0 w w 0 w 9- >- 1- 0 2 cr w 00 i z MECHANICAL PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE P.ARTS.OF.THE FORM YOU UNDERSTAND 20 1 Owner's Name (Last) irst) (M) ©e..../ e K, ,0 Department Use Only Project No. / ...„.0 2 Project Address (Not Mailing Address) / Space Zip Z� /4'Z 'r "` JT . L ,1- 3 City/Community Ar�� ,�_. a State r Subdivision`//Plat NameNa//�/ t_1..,#' Add £u r/ +• 4cv/% 2.4 0/ ,4d€ 4 065 2 - 29e s Parcel No. I Lot lock I 16 Contractor Firm NameStreet . 1 7 u Address /Y.z el tet'/ Afri_. 17 Zip 99 Z a ta,E City e State �4 sX Phone ( ) 3zC'-s-'e'°c) 18 Contact Person License No. Phone if different than above 8 Owner/Agent (if different than #1 above) Business Address g Zip City State Phone ( ) 15 Describe Work: New ❑ Addition/Alteration Replace/Repair ❑ 10 Applicant Name Street Address 11 Zip City State Phone ( ) 8 VENT: Fan(s): EvapCooler(s): Hood(s): Duct(s)1: Miscellaneous: 10 APPLIANCE: Dryer(s): I Range(s): Gas Log(s): Wood Stove/ Solid Fuel: Gas Water Heater(s): 11 UNIT HEATER(S): Wall Mount: Y N Floor: Y N Suspended: Y N 12 AIR HANDLING: 10,000 CFM or less: More than 10,000 CFM: 13 REFRIG SYSTEM BTU: 1-100M: 100-500M: 500-1000M: 14 1000-1750M: Other: Pressure Vessel (cu. t.): 15 COMPRESSOR/HP: Lessthan3: 3-15: 15-30: 30-50: 50+: 16 GAS PIPING SYSTEM: Number of outlets: 17 HEATING SYSTEM: 1-100,000 BTU: 100,001 + BTU: 18 TYPE FUEL SOURCE: Electric ❑ ; Gas 0 ; 011 0 ; Coal ❑✓Wood 0 ; Solar 0 19 TYPE DISTRIBUTION: Forced Air 0 ; Radiant 0 ; Heat Pump CT 1* Number of separate zones for any heating, A/C or air handling system. I certify that the above information as submitted by me is true and correct and further, agree that all pro- visions of laws and ordinances governing this type of work, including inspection requirements, will be com- plied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any state of local laws regulating construction or the performance of construction. SIGNATURE OF OWNER 0 APPLICATION DATE �` �"—